The present invention relates, in general, to surgical instruments for retrieving tissue and, more particularly, to a method of using an endoscopic surgical instrument such as a pouch or specimen retrieval bag for the removal of tissue through a small incision.
Endoscopic surgery is a procedure wherein surgery is performed through a series of small openings or incisions in a patient. This type of surgery reduces or eliminates the need for large incisions and has changed some of the major open surgical procedures such as gall bladder removal to simple outpatient surgery. Consequently, the patient""s recovery time has changed from weeks to days. These types of surgeries are used for repairing defects or for the removal of diseased tissue or organs from areas of the body such as the abdominal cavity.
Of interest is the removal or excision of biological material or tissue from the body through a small incision or small natural orifice. Tissue can have many types or forms but fall into three general categories: firm tissue such as muscle and solid tumors, soft tissues such as liver, and fluid filled tissues such as a cyst, a gall bladder, a spleen, or an inflamed appendix. Some tissue can be a mix of multiple categories. For example, an inflamed gall bladder can be a mix of hardened gallstones, fluids such as bile and pus, and an outer covering of firm tissue.
One challenge that exists with minimally invasive surgery is the removal of excised tissue through an opening in the body. A time-honored solution is the manual cutting of the large tissue mass into small pieces that can fit through the incision. However, with this process, fragments of tissue can be dropped and fluids can be spilled into the body cavity. This is serious if the excised tissue is cancerous or infected as this can lead to the seeding and re-spreading of cancer or the spreading of inflammation to healthy tissue.
In answer to the above challenges, surgical pouches or specimen retrieval bags were developed. The specimen retrieval bags are placed endoscopically into an inner cavity of the body, the bags are opened, and the diseased tissue is placed within. The specimen retrieval bags are closed to surround and contain the tissue and fluids within. Thus, the closed specimen retrieval bag prevents the migration of tissue and fluids from the bag into the inner cavity of the body. Once the diseased tissue is placed into the open specimen retrieval bag, the bag is closed and pulled from the inner cavity through an incision or trocar. Drawstrings are typically used to close the specimen retrieval bag in the body and to draw the bag out of the opening in the body. Surgical instruments of this type are described in U.S. Pat. Nos. 5,465,731 by Bell et al. and 5,465,732 by Tovey et al. which are herein incorporated by reference.
Morcellation instruments were also developed that can be used in conjunction with the specimen retrieval bags to chop or dissect large tissue masses within the specimen retrieval bags. When using a morcellation instrument, tissue is placed into the open specimen retrieval bag and the bag opening is partially drawn out of the body, leaving the tissue within the body cavity. Next, the bag is opened and the morcellator is inserted into the bag and into the portion of the bag still within the body cavity to morcellate the tissue. Suction can be used to remove morcellated tissue. A RF morcellation instrument and method of use are described in U.S. Pat. No. 5,957,884 by Michael D. Hooven and a description of morcellation is found in U.S. Pat. Nos. 5,465,731 by Bell et al. and 5,465,732 by Tovey et al.
Whereas this method of removing tissue from the body does work, it was awkward for the surgeon to hold the bag open while morcellating and suctioning to remove pieces of tissue. If care is not exercised, the bag can be punctured or the spillage of fluids or and tissue can occur. Additionally, costly, sophisticated specimen retrieval bags are required that are resistant to cutting from the mechanical morcellator blades or RF energy.
U.S. Pat. No. 5,681,324 by Kammerer et al. teaches that a square bottomed pouch (or specimen retrieval bag) enables the tissue specimen to lie across the bottom of the pouch and to impede the removal of the tissue through a trocar site (or incision). More importantly, Kammerer et al. also teaches that a tapered-bottomed pouch solves the square-bottomed pouch problem by aligning the tissue and makes it possible to remove tissue from the body cavity without enlarging the incision. Additionally, the tapered pouch shape reduces the amount of trapped air and reduces the ballooning effect when the pouch is closed and reduces the stress exerted on the pouch and abdominal wall tissue (caused by pulling the pouch through the trocar site or incision). Whereas the tapered pouch did indeed facilitate the removal of tissue, there is room for additional solutions to this problem, particularly when fluids are present within the specimen retrieval bag or within the tissue placed therein.
What is needed is a specimen retrieval bag that offers all of the advantages listed above by providing a pouch or specimen retrieval bag that is easy to remove from the body. Additionally, it would be advantageous to provide an improved specimen retrieval bag that makes it easier for a surgeon to remove a specimen retrieval bag that contains fluids or materials such as chunked or morcellated tissue that that flow under pressure. Presently, there are no known specimen retrieval bags that can provide the surgeon with the improvements and benefits described above.
A method of removing biological materials through an opening within a patient is disclosed, the size of the biological materials is being larger than the size of the opening within the patient. The method includes providing a bag having an open and a closed end, and a longitudinal axis extending therebetween. The bag has at least one wall and at least one material transfer member attached to the wall adjacent to the open end. Furthermore, the material transfer member extends radially from the wall and is in fluid communication with the bag. Next, the bag is inserted within a patient through an opening within the patient and biological materials are inserted within the bag. The bag is moved adjacent to the opening within the patient. Then the open end of the bag and at least a portion of the material transfer member are removed from the patient through the opening by applying tension to the open end of the bag. This action compresses the biological materials within the bag and reduces the size of the biological material within the patient by transferring a portion of the biological materials within the patient through the opening and into the portion of the material transfer member removed from the patient. Finally, the entire bag is removed from the patient through the opening.